Biliary obstruction following ureteral revision of a transpl
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A 66 year old woman with a history of two prior kidney transplants secondary to systemic lupus erythematous presented with biliary dilation. In 2002, she had a first renal transplant to the right external iliac vessels with ureteroneocystostomy. Three years later, she developed a long segment ureteral stricture extending proximally from the ureteroneocystostomy anastomosis with transplant hydroureter and graft hydronephrosis. This was initially managed with stenting and percutaneous nephrostomy tube. Ultimately, the patient underwent proximal ligation of the right native ureter and end to end anastomosis of the transplant ureter to the native ureter in continuity with the bladder. This graft ultimately failed, and she received a second renal transplant to the left iliac fossa in 2012 with excellent renal function.

Beginning in 2015, she noted intermittent epigastric pain and mild nausea, increasing in frequency and severity. Her liver function tests and bilirubin levels were normal. An abdominal ultrasound in 2015 identified right native kidney hydronephrosis versus cyst and an 11 mm common bile duct. A magnetic resonance cholangiopancreatography (MRCP) in 2018 demonstrated gallbladder distension, severe intra and extrahepatic biliary dilation, and dilation of the pancreatic duct to 5 mm. After intervention, her symptoms resolved. She elected not to pursue repeat imaging.

Read more : https://onlinelibrary.wiley.com/doi/10.1111/ajt.16361?af=R
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